Taking action in an asthma emergency


Asthma can be life-threatening and shouldn't be underestimated. Watching somebody gasping for breath is a terrifying experience and being well-prepared is the best advice.

Practical tips are: 

  • Know the early warning signs and symptoms. There are usually many warning signs of an impending asthma attack, and one of them is lowered peak flow measurement. You can monitor your condition by regularly checking your peak flow. Other symptoms may not be as obvious.
  • You may want to give a list of these symptoms to friends, family and work colleagues, together with an action plan and a written set of instructions on what to do in an emergency. This should be displayed in a prominent place so that everyone knows what to do when an asthma attack occurs. This is of particular importance if you are a high risk asthmatic with partly or poorly controlled asthma.
  • Don’t forget to have the telephone numbers of your doctor and the local hospitals readily available in the event of an emergency. 
  • Severe asthmatics are also advised to have oxygen at hand and to get to the emergency service at the local hospital as quickly as possible.
  • In milder attacks, the sufferer can get relief by using their bronchodilator. If you live far away from medical services, or where transport modalities are not easy to come by, an emergency course of oral cortisone may be commenced. However, consult with your doctor before taking it.

There are a number of different questions which determine how much time a patient has before it’s too late and the sequence of actions to be taken:

If you're using your reliever and you have an acute attack, administer two puffs.

If you have a spacer, use it with the pump, so that the spray can get down deeply into your chest. 

If it's very bad or didn't work, use five to 10 puffs in a row.

If this still doesn't work, you need to get to hospital – but remember to take your pump with you and keep giving yourself five to 10 puffs along the way. It's not about how much time you  have, it's about how bad the attack is and how the patient is responding to the treatment.  

The ALA stated that in the case of a moderate/mild attack, again asthma medicine prescribed for an attack should be taken, as this should open up the airways in the lungs in minutes. If it doesn't work, the doctor should be called.

In more moderate and mild attacks, which are in fact the more common type, there is:

  • Tightness in the chest
  • Coughing up of mucus
  • A feeling of restlessness and often trouble sleeping
  • With a wheezing or whistling sound when breathing

In some cases, when the attack appears to have eased up, a second wave, which is more dangerous, can hit. This happens when the airways continue to swell, and this can last for days or even weeks. It can also happen even if there are no asthma symptoms and can even trigger more attacks as the lungs become more sensitive to other irritants. The second wave often sees patients admitted to hospital and given medicine to reduce the swelling in the air tubes and relax the tightened muscles.

Identify an asthma emergency
If you show any of the following symptoms of acute, severe asthma (an emergency), despite using your reliever for two puffs, then for 5 to 10 puffs in a row without any significant relief, you need to get to a hospital.

Get to the closest hospital or clinic (but remember to take your pump with you and keep giving yourself five to 10 puffs along the way) if you have any of the following symptoms:

  • Wheezing usually loudly or noisy breathing.
  • Breathing fast (more than 30/minute) or irregular breathing, trying to clear throat.
  • Unable to speak in sentences.
  • Anxious look, flared nostrils (with pulse rate higher than 120/min).
  • Spaces between ribs visible when sucking in air (more prominent in a child), or your peak flow having dropped below 60%).
  • Hunched-over posture.
  • Paleness or blue colour around mouth, sweating, fatigue.
The American Lung Association (ALA) describes asthma attacks as severe, moderate or mild.

Severe attacks lead to:

  • Breathlessness
  • Trouble talking
  • Neck muscles becoming tight during breathing
  • Lips and fingernails turning grey or blue
  • Skin becoming tight around the ribs

In the case of a severe asthma attack, they recommend that asthma medication should be taken as prescribed. Emergency assistance should then be called for immediately.

At the clinic or hospital, you'll probably receive the following emergency treatment:

  • Oxygen
  • More of your inhaled reliever therapy
  • Inhaled anticholinergic therapy (a strong bronchodilator)
  • Plus corticosteroid tablets or an injection
Who is most at risk of dying from asthma and should be monitored carefully?
You may be at greater risk of death from asthma if you:
  • Have a past history of sudden, severe asthma attacks.
  • Have been admitted to an intensive care unit for asthma once or more.
  • Have been hospitalised for asthma two or more times in the last 12 months.
  • Have had three or more emergency care visits for asthma in the past 12 months.
  • Have been hospitalised or have had an emergency care visit for asthma in the past month.
  • Use more than two canisters of inhaled short-acting beta-2-agonist each month.
  • Have difficulty perceiving airflow obstruction or its severity.
  • Are poor and live in an urban setting.
  • Use illegal drugs.
  • Have a serious psychiatric disease or have psychosocial problems.
  •  Are allergic to outdoor mould.

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